The CEO of a local mental health provider has called the allegations of Medicaid fraud against his company "completely unfounded." Meanwhile, the Idaho Department of Health and Welfare feels they have more than enough evidence to make their case.
"We had absolutely no forewarning this was coming, completely surprised," said Dr. Heath Sommer, CEO of Seasons of Hope. "In fact, our most recent conversations with the investigators led us to the conclusion that we were communicating well."
"(Last summer), the fraud unit was looking at the records and then there were communications with Seasons of Hope" said Tom Shanahan, Public Information Manager with the Idaho Department of Health and Welfare. "Then in January, we had two analysts sit down with Heath Sommer and go over everything, most of the things that were in the letter. Some of the problems continued and at that point immediate action was taken."
Earlier this week, Seasons of Hope had Medicaid payments frozen by the Idaho Department of Health and Welfare after the Department believed that over $400,000 of fraud had occurred at the company between June of 2010 and January of this year. Sommer told KPVI News 6 this week that he felt the investigation was secretive and unfair. But Tom Shanahan says his department stands by all of the accusations and the actions taken.
"The Medicaid Credentialing Program was routinely examining patient files and they found quite a few discrepancies in the files," Shanahan said. "They contacted the fraud unit and that was last May."
"We would also like to see the evidence behind the accusations that have been made and have repeatedly asked for that evidence," said Sommer.
"I think the letter speaks for itself," Shanahan said. "We've identified things that should not have been paid and we'll just have to see if he does appeal and how it plays out."
"It seems extraordinary to us that more or less a committee would jump to a conclusion of fraud before we even had a chance to be represented or make our claim," said Sommer.
"Federal law requires us that if there's an allegation of fraud, substantiated allegation of fraud, we need to basically stop payment immediately," Shanahan said.
Seasons of Hope has a total of 28 days to appeal the case and you can find more information by clicking the links at the top of the page.
As far as criminal charges go,Shanahan says the Idaho Attorney General's Office would make that determination.